Posted in Genitals: A User's Guide, Uncategorized

Seeing Red…

I’d like to take a look at periods!

Even though it’s an *extremely* common experience – there are estimates that 800 million people in the world are having a period every single day – this is one of the topics that often gets the most ‘yucks’ and discomfort in schools.

In my experience, people often have misconceptions about periods in the UK. Despite this, I find that there’s a tendency to talk about period stigma as a purely foreign problem – often only acknowledging problems in low income countries. Unicef recognises that period stigma is a global issue.

As someone who regularly talks to young people about menstruation, it seems sadly alive and well in the UK. Often, just bringing out (completely new and unopened) tampons and other period products is enough to evoke palpable – and audible – signs of discomfort in the classroom. I firmly believe that the way to tackle this is to talk to all people about periods – whether they have them or not themselves…

Firstly, let’s start with the basics – what is a period?

It’s bleeding through the vagina from the uterus, usually for a few days, most often once a menstrual cycle (more on variations and problem periods later). The bleeding is the lining of the uterus being shed. It’s made up of clots, tissue and blood – so is very different to the ‘fresh’, bright red blood you might get from veins or arteries from a cut.

Usually (but not always) people use something to manage this bleeding. Different types of period products include:

Pads: Either disposable or reusable material that is attached to underwear and soaks up blood. Disposable pads are widely available. They usually contain some sort of plastic to make them waterproof and are single use – i.e. they are thrown away after being used. Reusable pads are made from fabric and can be washed and reused. At least in the UK, they can be a bit harder to get hold of. Some brands sell them online, or independent makers sell them through websites life Etsy.com. If you are craft savvy, you might like to make them yourself.

Tampons: These are cylinders of cotton wool-like material. They are inserted into the vagina. The walls of the vagina keep them in place, where they can absorb blood. They are removed by pulling on a little ‘string’ attached to them. Concerns about tampons getting stuck, lost or causing harm seem quite common. Although people do sometimes find they can’t remove a tampon, this doesn’t seem to happen very often. Even if it does, the vagina is a closed ‘space’ and a healthcare professional should be able to remove it using special tools (I have had this job at one point). Like anything that is inserted in to the body from outside (including food) there is always going to be some risk of infection with inserting a tampon. Again, this isn’t very common, especially if tampons are removed and changed regularly and you make sure to wash your hands before removing or inserting one.

Period Cups: Shaped a bit like an egg-cup without a stand and made from a squishy but solid material. They are inserted in to the vagina, where they sit underneath the cervix (entrance to the uterus) and collect blood. They can then be emptied and washed – rinsed out in between uses and sterilised (e.g. in boiling water) in between cycles. They usually have a little ‘pull’ on the end that can be used to remove them – a bit like the string on a tampon. Along with fabric pads, they are another type of reusable period product.

Period Disks: They work in a similar way to period cups – but are shaped differently. They are a flattish ‘disk’ shape, rather than a ‘cup’ shape, but are still inserted in to the vagina, where they sit and collect blood. They don’t have the little ‘pull’ piece, and sit a bit higher up in the vagina.

Pants: These are shaped and worn like regular underwear. But the ‘gusset’ (the bit that sits underneath the vagina in people with vulvas) is made from absorbable material, to soak up period blood. As with reusable pads, these are washed and then reused.

Freebleeding: Some people don’t use any particular product when they are menstruating – bleeding ‘freely’ on to their clothes. This can be by accident, or it has been used as a political statement.

Busking it: Sometimes people use anything to hand, such as tissues or cloth, to soak up period blood. One reason for this might be period poverty – the inability to afford period products. It is thought that millions are affected by this, even if high income countries like the UK.

How do people choose which period product to use? People are different – and what is good for some, isn’t for others. Also, your needs and your cycle might change over time or in different circumstances. For example, personally I like to use a period cup during the day because it can be reused and is fine to take swimming. But at night I prefer period pants, as they feel more ‘secure’ which I’m moving about in my sleep.

Another thing that doesn’t get talked about very much is problem periods. There’s sometimes a feeling that periods are meant to be unpleasant – for example, painful. Whilst some discomfort is common, there is such a thing as as a problem period. A period might be a problem might be one that:

  • Is too painful (e.g. effects your ability to do the things you would usually do), including pain just before your period.
  • Is very heavy (e.g. you have to change pads or tampons very frequently or no period products seem to deal with period blood at all), including last for a very long time (i.e. longer than 8 days).
  • Causes you lots of emotional distress, including just before your period.
  • Is very irregular (e.g. your cycle varies by more than several days between each period).

If this or something else is bothering you about your period, it’s probably worth talking to a healthcare professional – like your GP – about it!

Resources:

I cannot recommend the book Red Moon Gang by Tara Costello enough, for anyone who has periods (or who doesn’t, and wants to know more). Informed by Costello’s extensive research, as well as interviews with what seems to be a huge range of people who have periods (including people of different genders). There is also a blog and information site of the same name, which includes a really nice and short article on what a period is!

I wrote ‘The Body’ chapter in Sex Ed: An Inclusive Teenage Guide to Sex and Relationships, which is available from Walker Books now! This chapter includes loads of information about periods, and the rest of the book is full of other RSE info for young people!

This video from Amaze.org is a nice summary of the basic of a period (although briefly gets a bit reproductive focused).

Episode 23 of the Guilty Feminist is all about Periods! Nice, normalising discussion of periods. The guest on this episode is Evelyn Mok, who talks about being diagnosed with PCOS (i.e. problem periods).

This short film about getting a period for the first time might be a nice conversation starter!

Follow the Bloody Good Period campaign on social media for period education.

I am the Co-Founder of PeriodPal – an online app for tracking periods that aims to be inclusive and ethical. This is funded by donations, with no subscription fees. To sign-up for a free account to track periods and your health, go to periodpal.eu.

Posted in Anatomy, Genitals: A User's Guide

Rubber Band Theory…

In schools at least, some variation of this question is reasonably common – people worry either that a vagina isn’t big enough to accommodate a penis/sex toy/ tampon, or that it will become stretched out of shape by any of those things.

The vagina is a tube, about 8cm long. It isn’t quite hollow – but it can stretch a lot. To make space for a baby’s head, for example – which is much  bigger than pretty much any penis.

The vagina might change shape after childbirth (after any number of children). But the idea of it becoming ‘baggy’ is probably more of an exaggeration.

 

 

Posted in Anatomy, SRE

Lark in A Park

As well as facilitating Sex Ed workshops in schools for the last month, I’ve been involved in a few events aimed exclusively at adults.  Although the style of presentation has been different, these have all involved using an arts & crafts or D.I.Y approach.  These events reaffirmed my belief in this as a particularly good medium for exploring personal issues in a fun, engaging and accessible way.

The first was a ‘genital making’ workshop, hosted by the Candid Collective.  Adapted from an activity used to teach children about anatomy, puberty and health, this saw us showing adults how to make vulvas and penises with air drying clay to then be turned in to fridge magnets!  Held in a cosy upstairs room of a pub in South London, it had a very different feel to the classroom and was lots of fun.

The second was a talk for the antiuniversity lecture series – in which a group of us took to a local park to talk about arts and craft as a medium for discussing bodies and our own experiences of sex ed.  This culminated in making a ‘zine page about some of the issues that had been brought up.

There are a couple of future crafting themed sex and relationship events (in London) for adults that you may be interested in:

Thanks to Lisa, Leah, Adam and Bel for the images!

 

 

 

Posted in Genitals: A User's Guide, Uncategorized

By Design

Ever heard the term ‘designer vagina’?  This generally refers to a certain type of cosmetic surgery, not to the vagina itself but to the ‘inner lips’ (or labia minora) of the vulva.  Surgery here involves removing tissue from and reshaping the appearance of the labia minora- in other words to ‘trim’ it.   Many people with vulvas have a labia minora that protrudes so that it appears visible – therefore however large this is it is likely to be ‘normal’.  Additionally, in young people biological changes occur during puberty that can change the appearance of the inner labia.  For this reason it is often recommended by the NHS that those under 18 do  not get this type of surgery.  However, there seem to cases of children having labiaplasties.  According to one report over 200 people received labiaplasty procedures funded by the NHS in 2015-2016.  We know that people with visible labia are more likely to think that their genitals look ‘abnormal’ than those without, even though both are equally common (Lykkebo et al, 2017). Some accounts have blamed this on the prevalence of seeing only vulva with neat and invisible labia minora.  Whatever the cause, the desire to have this type of surgery seems increasingly common with a 45% rise seen in labiaplasty numbers worldwide between 2015 and 2016.

 

 

 

Posted in Genitals: A User's Guide

Dare to Hair

Pubic hair and body positivity can be a tricky issue. On the one hand, people absolutely have the right to cut, shape, dye, remove or in any other way sculpt their own personal body space! I get how it can be liberating and a way of taking control of your own body and quite literally shaping your intimate identity.

On the other hand, there seems to be a growing repulsion for body hair that isn’t manicured. A dislike for ‘natural’ hair, particularly (but not exclusively) when it comes to vulvas. Some people specifically find it ‘unhygienic‘. This despite the fact that pubic hair, like the hair on your head, has specifically protective functions.

So trim and go as bare as you dare around your nether regions if you want to. But maybe think about why your doing it!

Posted in Genitals: A User's Guide

A Cock and Bull Story…

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Rounding off the year, let’s have a look at penises!  We (the societal ‘we’) tend to be a bit more familiar with the constituent parts than we are with vulvas…

Glans: This is the tip or ‘head’ of the penis.

Foreskin: This is a fold of skin that covers the glans of the penis.  It can be removed, either at birth or later in life, for either medical or cultural reasons in a process called circumcision.  Rates of this practice vary across the world and it isn’t as common in the UK as in other parts of the world.

Urethra: The opening of the penis.  Semen, urine and discharge can leave the body here.  As with discharge from the vagina, this can be normal.  Changes in the discharge (e.g. smell or colour), especially when accompanied by other symptoms (pain, itchiness) can however indicate something’s not quite right and might need checking out.

Shaft: This is the main bit of the penis.  Internally are found the tubes that carry urine and semen out of the body, as well as blood vessels supplying the penis – this is part of the mechanism that causes the penis to become hard and bigger during an erection.

The average penis size is 9 cm when not erect, although there is a fairly large and health variation in this.

Posted in Genitals: A User's Guide

But, Am I Normal?

We seem to sometimes fall in to the habit of talking about ‘discharge’ from the vagina as if it’s always bad thing- for example as a sign of an infection.  It can be easy for forget that it’s also a healthy part of how this bit of your vulva works.  The vagina produces a mucousy discharge that helps keep it clean and protects from infection.  But what is it ‘meant’ to look like?!  Healthy discharge should be:

  1. SMELL – not strong and/or unpleasant.
  2. COLOUR – clear or white.
  3. CONSISTENCY – thick and sticky or slippery and wet.

It’s perfectly normal for it to vary a bit with age and during different bits of the menstral cycle, but as long as it’s within these parameters, it’s all perfectly normal… so now you know!

 

Posted in Genitals: A User's Guide

Playing Around

The information here is adapted from an exercise from Sexplain UK, used as part of their SRE lessons.   In short, it involves using play dough to build genitals.  This exercise can be used to teach people about external genitalia (both penises and vulvas).  As an arts and crafts activity, it can be fun and engaging and help to give something concrete to talk around in terms of things like physiology, variation and health.   I have also included the recipe I use for homemade play dough.

To make your dough.

Ingredients:

2 cups plain flour

1 cup of salt

2 teaspoons cream of tartar

1 tablespoon of vegetable oil

2 cups of boiling water

Something to colour the dough with (optional) such as food dye, paint powder, or a crushed soft pastel

Instructions:

Put all of the ingredients except for the water and colouring in to a large mixing bowl.  Boil water and add this to the mix whilst still very hot.  Mix immediately using a wooden spoon.  Once the mixture is cool enough to handle, put some flour on a surface and lightly knead the mixture for a short time.  If you are adding colouring, now knead this in until the dough is roughly all the same shade throughout.

Make sure the dough is left uncovered until it is cool, then cover in an airtight container.  It should last for about a week.  This recipe makes enough for about twelve people if doing the exercise below.

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Vulva models made from play dough recipe

 

So, all foetuses have the same general genital structures, regardless of what sex they will become.  They then typically (but not always) differentiate in to either a penis or vulva.  These are the external genitalia (i.e. the bits you can see).

We’ll look at vulva first, as this is the one people tend to find a bit trickier.

Take your ball of play dough and divide it in to four pieces.  With one of these quarters, make a left or diamond shape:

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This is the vestibule of the vulva.

Next, take another quarter and roll it in to a sausage shape, about the length of one side of the vestibule and attach it to one side:

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This is the labia majora, the fatty tissue that covers the whole vulva and tends to be covered in hair after puberty.  Complete it by making another sausage to attach to the other side:

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Next, divide the last quarter in to two.  With one piece, make a smaller sausage to attach inside one side of the labia majora.  This can be flattened if you like:

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This is the labia minora.  In about half of people with vulvas, the ‘inner lips’ of the labia minora sit outside of the bigger ‘outer lips’ of the labia majora.  Let’s complete these.  As with the labia majora, it’s not a problem if they aren’t exactly symmetrical:

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Next, let’s make a very important structure: the clitoris.  Either take a little ball of extra dough, or pinch a piece off from your existing structure:

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The bit we can see here only represents the external part – it extends to be a much bigger structure internally.  The clitoris is made of very sensitive tissue, with lots of nerve fibres.  Some people find it arousing or stimulating when touched gently.

To complete, let’s make the ‘holes’ in the vulva.  Get people to guess how many ‘holes’ the vulva contains (guesses I’ve heard range from one to twenty!).  For this model, we’ll be looking at two (you can explain that some people talk about a third, the anus, which is actually outside/below the vulva).  The first is about a third of the way down and can be marked with a finger or a pencil:

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Get students to guess its name – the urethra, and it’s function – carries urine away from the body.  It is separate from the next hole we’re going to make.  This hole is nearer the bottom of the vestibule and can be marked by making a hole all the way through:

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Again, you can get people to guess the name (vagina) and point out that this is the name people often use (incorrectly) to refer to the vulva. You can talk about things that come out of the vagina – i.e. blood (periods), babies and discharge (either healthy or a sign of otherwise, such as thrush or bacteria).

Next, we’ll make a model of a penis.

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This time, divide the dough in to two pieces.  With the first piece, make a sausage shape:

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This represents the shaft of the penis.  We can then make a little distinct area by marking out the end:

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This is the glands of the penis, which tends to be more sensitive than the shaft.  Next we can make a hole in the end (with a pencil or finger).  This is the urethra or the penis.  Three things can come out of this – urine, ejaculation or discharge.

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Give people the option of making a foreskin – pinch off a little bit of dough and fashion in to a thin rectangle to cover the glans.  This is a good point to talk about hygiene – e.g. washing with water and changes during puberty, as well as circumcision.

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Next, we’ll finish off with making the testicles (scrotum).  There is a good chance that students will already have made them with the other half of the dough by making two balls and attaching these to the base of the penis:

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This is fine and validate this.  Also explain that you can make them from a ‘teardrop’ shape and attach that.  You can talk about the misconception that ‘balls drop’ (i.e. they get bigger and hang lower after puberty, but don’t actually ‘drop’ further out of the body).

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It can be a nice idea to get the students to look at and reflect on how different all of the bits are.  Lots of them seem to ask what ‘normal’ is – this can be a good place to point out that this is something that is highly individual.

We often talk (briefly) about the concept of it being possible to be biologically ‘intersex’ – i.e. it is possible to have someone who doesn’t have external genitalia that fall neatly in to either of these categories.

It can also lead on nicely to talking about internal genitalia and reproductive functions.

 

Posted in Genitals: A User's Guide

It’s What’s Inside that Counts?

My weakest area at med school was definitely anatomy. I enjoyed it though. Each week, we would go to the anatomy suite where the cadavers were kept and I would learn another thing I was previously mistaken about. The relationship between what we see and understand on the outside and what and where it is on the inside is often not straightforward.

The stomach, for example, is not the low down bit of the abdomen people hold when they have ‘bellyache’ – that’s more like bowels. This is part of the gut, but with has a distinct and different function. What a lot of people think of as the ‘vagina’ (the passage from the external body to the womb) would actually be better described as the ‘vulva’. In my experience, these misconceptions are rife in ideas about our reproductive organs. Let’s have a look at some of the internal xx anatomy…

Vagina: a passage leading from the outside to internal parts. It’s made up of muscular, stretchy tissue that can deform and accommodate various things (tampons, fingers, foreign objects, a baby…).

Cervix: the lower bit of the womb. Roughly tube shaped and typically around 2-3cm long. It has a hole (the cervical ‘os’) which leads from the vagina to the womb. It can change shape, size and consistency under hormonal control – e.g. getting smaller and opening during childbirth.

Uterus: Or ‘womb’. This is where a baby can grow. Sits just behind the bladder in non-pregnancy. The lining of this cavity is called the ‘endometrium’. It is the endometrium thickening and then shedding that is experienced as periods. The top bit of the uterus is called the ‘fundus’.

Fallopian tubes: connect the uterus to the ovaries. Also called the ‘salpinges’ or a ‘salpinx’. Each one ends in a ‘fimbria’. This is a little fringe of tissue that helps convey eggs in to the tubes from the ovaries.

Ovaries: whitish lumps of tissue where eggs are released from. They also produce hormones so have an important endocrine role.

All of these structures sit quite low down in the abdomen. Sometimes problems that feel like they are coming from this reproductive tract can be mistaken for problems with the bowel and vice versa. We’ll have a look at some of these problems another time…